The healthcare system consistently exhibits differential treatment towards the Black community. Despite ongoing efforts to address health resource disparities and services, spanning from local clinics to national governance, altering the impact of kidney disease on African Americans remains a challenging endeavor. Susceptibility to chronic kidney disease (CKD) is deeply rooted in DNA, and while strides have been made in medical research and genetic testing for gene mutations, treatments are still pending.
Unraveling Chronic Kidney Disease
Chronic kidney disease, which stems from kidney damage, is more prevalent than commonly acknowledged. Although diabetes and high blood pressure stand as the leading causes, various autoimmune disorders, including Lupus, also target the kidneys. Factors such as frequent dehydration and recurring urinary tract or bladder infections can gradually contribute to kidney disease. Polycystic kidney disease represents a genetic variant that intensifies kidney damage over time, impacting blood filtration efficiency.
Diminished kidney function leads to inefficiencies in filtering blood, allowing toxins to accumulate, causing discomfort and potentially damaging other organs. This condition might be transient during recovery from an illness, but more frequently, it evolves into a long-term ailment characterized by gradual function loss.
Recognizing Symptoms
Certain signs of chronic kidney disease can be misconstrued as minor ailments like dehydration, making them easy to overlook. These include fatigue and darkened urine. Swelling in the lower legs might be familiar to those with diabetes. Yet, some symptoms warrant immediate attention from a healthcare provider, signaling chronic kidney disease.
Nausea or vomiting
Muscle spasms or cramps, especially in lower limbs
Trouble concentrating or confusion
Sleep disturbances
Dry and itchy skin
Metallic taste or diminished appetite
Risk Factors for CKD
Numerous individuals are at higher risk of developing chronic kidney disease, often unaware of this vulnerability. Kidney disease can rapidly progress without intervention. Those possessing one or more of the listed risk factors should discuss them with a healthcare professional.
Diabetes
Hypertension (high blood pressure)
Heart disease
Over 60 years of age
Long-term use of pain relievers (particularly NSAIDs)
Family history
Ethnic background
Treating Kidney Disease
The spectrum of kidney disease comprises five stages, ranging from minimal damage and normal function in early phases to end-stage kidney disease with limited or no function. Complete kidney failure necessitates dialysis to eliminate waste from the blood, with a potential kidney transplant. CKD treatment varies based on kidney function, concurrent health conditions, and other factors. Collaborative effort with a nephrologist, possibly other specialists, and primary care providers is essential to manage disease progression effectively.
Why Kidney Disease Differs for Black Individuals
Black individuals grappling with CKD face additional hurdles. From biological factors and DNA to healthcare system-related racism, kidney disease presents differently in the Black community.
Systemic Bias
Racism has deeply permeated the healthcare landscape for decades, contributing to systemic prejudice against Black individuals, evident in access to healthcare resources and services.
Healthcare Accessibility
Numerous research bodies and academic publications confirm healthcare disparities within the Black community. Impoverished neighborhoods often lack well-equipped medical clinics and adequate health insurance coverage. Many Black Americans lack primary care providers for preventive measures, even for conditions like high blood pressure, hindering early detection of most chronic illnesses.
Suspected chronic illnesses in the Black population are less likely to be investigated with testing, even basic urine tests, or referral for advanced care. Although efforts to address these disparities are underway, progress is slow, contributing to diminished quality of life for those afflicted with a range of ailments, beyond kidney-related conditions.
Diagnosing Kidney Failure among African Americans
The glomerular filtration rate (GFR) is a standard blood test gauging kidney function. A longstanding belief was that GFR results were higher in African American adults, backed by insufficient clinical studies. Subsequently, a task force concluded that GFR equations should apply equally to both African American and Caucasian patients. This shift enhances accuracy, simplifying early detection.
Revamped Transplant Criteria
NBC reported in February 2023 that changes were implemented in determining patient priority on the kidney transplant waiting list. According to Dr. Martha Pavlakis, race variables inclusions are inaccurate, and the outdated GFR lab test has been banned. African Americans on the transplant list will receive credit for time, potentially securing a kidney transplant one to two years sooner. Before this change, the average wait for African Americans was 64 months, compared to 37 months for non-Hispanic whites.
A study in Current Transplantation Reports supports this, attributing “structural racism” to Blacks’ reduced access to living donor kidney transplantation (LDKT).
Co-existing Factors
Diabetes and hypertension are predominant kidney disease causes. The Office of Minority Health (US Department of Health and Human Services) indicates that nearly double the number of Black Americans have diabetes compared to non-Hispanic white individuals. Additionally, over half suffer from high blood pressure, which tends to manifest earlier and more severely. Many individuals fall into both categories, as one condition predisposes them to the other.
Further ailments, such as cardiovascular diseases, disproportionately impact the Black community. Black women are particularly susceptible to autoimmune diseases like Lupus, which targets the kidneys and may lead to NSAID usage for joint pain control.
Chronic kidney disease treatment often involves managing underlying health conditions, necessitating access to consistent healthcare and medications, posing challenges in communities grappling with economic disparities.
Genetic Predisposition
Apart from underlying medical conditions, a common gene mutation could elevate the risk. Dr. Opeyemi Olabisi of Duke University elucidates this mutation’s effects for the New York Times. The APOL1 gene, present in those of sub-Saharan or Afro-Caribbean descent, serves as a defense against African trypanosomiasis. However, inheriting two mutated gene copies heightens the risk of kidney disease. Similar to a gene fostering immunity against malaria, this mutation inadvertently amplifies vulnerability to sickle cell disease.
Ongoing medication trials target these gene mutations to treat chronic kidney disease at its source. Genetic testing may identify those at risk, though the presence of both mutations does not guarantee disease development. However, awareness of vulnerability could exacerbate high blood pressure and stress, further contributing to risk factors.
Transforming Healthcare
Fortuitously, the healthcare system is gradually evolving to ensure equitable care regardless of race or income. Although changes are gradual, several transformations are already evident:
Tackling Social and Economic Disparities
Enhancing Access to Culturally-Sensitive Care
